A tisket, a tasket, a green and yellow basket of HIV pearls (part 1)

Era and I have been fortunate to learn a ton from the HIV experts here – many of which came up in report today. Here’s a few of my faves.
The nadir is critical for assessing degree of immune compromise
  • The nadir is the lowest CD4 count which has been recorded in the patient’s HIV course – usually when they are off ART or haven’t started it yet.
  • If a patients stops taking ART, their CD4 count rapidly drops to their last nadir.
  • When you evaluate a patient in whom you suspect medium or long term non-adherence, you should suspect their CD4 is at their nadir. 
PCP is hard to diagnose definitively, common (in AIDS patients), and deadly. Know the illness script then use your pretest probability + rapid, imperfect tests to decide on empiric treatment.
An extremely elevated ferritin in patients with AIDS has a short differential
  • It’s most suggestive of histoplasmosis, cocci and disseminated TB
  • Other things on the epic ferritin ddx in general
    • HLH
    • stills dz
    • lymphoma
    • acute liver failure
    • SLE
I’ll try to post another set of these next HIV/ID report. Let me know if you have favorites for me to highlight!

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